关节镜下手术治疗肘关节僵硬

Arthroscopic surgery for treatment of stiff elbow

目的探讨关节镜下手术治疗肘关节僵硬的临床效果。方法2003年12月-2006年12月，采用关节镜下手术治疗肘关节僵硬15例。发病到手术时间为6个月至20年，平均39．6个月。采用前外侧、前内侧、后外侧正中、后外侧上方四个人路进行镜下清理和松解术，3例附加后正中入路施行镜下鹰嘴窝开窗扩大成形术，最后行手法松解。结果术后随访时间为18～36个月（平均26．3个月）。术前肘关节屈曲活动度为[（100．0±13．1）°，x±s，下同]，伸直活动度为（47．9±11．9）°，活动范围为（52．1±11．6）°。术后肘关节屈曲活动度提高到（133．0±19．4）°，伸直活动度提高到（8．7±8.8）°，活动范围提高到（124．3±27．3）°。肘关节功能评分：优2例，良8例，一般4例，差1例；优良率为67％。结论肘关节镜下手术具有创伤小、出血少、恢复快及视野清晰的优点，但治疗效果并不一致。对于关节软骨损伤严重者，手术可能不能完全阻止疾病的发展，临床上应慎重开展。

Objective To evaluate the results of arthroscopic surgery for treatment of stiff elbow. Methods From December 2003 to December 2006,15 cases of elbow stiffness were treated arthroscopically. The time duration from onset to surgery ranged from 6 months to 20 years （mean, 39.6 months）. Four portals （anterolateral, anteromedial, postero-lateral-central, and postero-lateral-upper） were routinely used for arthroscopie debridement and release. A posterocentral portal was added to perform olecranon fossa fenestration enlargement plasty under arthroscopic control in 3 cases. Finally, manual release was performed. Results All cases were followed up for 18 to 36 months （mean, 26.3 months）. Before the surgery, elbow flexion was （ 100.0 ± 13.1 ）° extension （47.9 ± 11.9）°, and the arc of motion was （52.1 ± 11.6）°. At the last follow up, elbow flexion was improved to （ 133.0 ± 19.4）°, extension to （8.7 ± 8.8）°, and the are of motion was improved to （124.3 ± 27.3）°. According to the modified Andrews elbow rating scale, results of 2 cases were rated as excellent, 8 cases as good, 4 eases as fair and 1 case as poor. Thus, the excellent and good rate was 67%. Conclusion Arthroscopic surgery to treat elbow stiffness has such advantages as minimally-invasiveness, less blood less, fast recovery and dear visualization. However the results are not always consistent. As for eases with serious cartilage damage, it seems that arthroscopic surgery cannot completely prevent progression of the disease. Therefore, the surgery should be indicated with a cautious manner.